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FAILURE TO COMPLETE ALL ITEMS WILL RESULT IN DELAYS. Application Date ICTS Status Code: For Office Use Only Last Name First Name Employee ID Serial # (Police/Fire Only) Driver's License # M.I. For information, please call (213) 978-1655. M. I. Employee ID Department Name Payroll Fund Number Class Title Work Address: Building Name or Street Address Room Number Work Shift (4/10, 5/40, 9/80, ect) Start Time Continuous Service Date Groupwise E-mail Address End Time List Below T.

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